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Change Healthcare Payment Accuracy Concept Specialist in Topeka, Kansas

Position Summary

The Payment Accuracy Concept Specialist creates and develops new clinical content for Change Healthcare’s Cloud secondary editing solution. The clinical concept analyst will work with a team to perform data mining services to identify opportunity of claims overpayments. The clinical concept analyst will be responsible for interpreting claims data, analyzing and building claim payment policy, and building the clinical content. This role is responsible for the comprehensive analysis, development and maintenance of clinical content supporting the product business rules and content. The concept analyst also supports educating customers on the content.

An important dimension of this role is to help develop and mature the Services model for Emerging solutions. This new and innovative approach to delivering customer value focuses on a framework including the following:

  • Opportunity Evaluation, Analysis and Data Mining

  • New Opportunity Vetting with Customer

  • Deployment Planning

  • New Opportunity Implementation

  • Monitoring and Measuring

  • Solve problems by identifying errors and overpayments in claims paid data

  • Generate new ideas for claim rule and edits (pre payment)

  • Communicate in an effective manner to socialize concept and drive towards realistic savings opportunity for each concept

  • Stay abreast of new coding/billing/overpayment trends

In each step, the team (including this role) will work to build a framework, process and templates to develop and deliver these solutions to our clients. Going beyond typical default rules in CXT is expected to be part of that model…a mix of edits that could be clinical, coding, payment policy and query or data mining based.

Key Responsibilities

Research various data sources and clinical content documentation (clinical content meaning CPT, HCPCS, ICD-10-CM, ICD-10-PCS, & all other code sets) opportunities. Research includes but is not limited to:

  • Medical coding guidelines,

  • Medical billing guidelines,

  • Clinical literature,

  • Audit reports,

  • National coding standards,

  • CMS transmittals,

  • CMS payment policies,

  • Regulatory policies,

  • Consultant feedback,

  • Specialty society guidance,

  • Peer reviewed clinical journals, when appropriate,

  • Client feedback

  • The Clinical Content Developer/Analyst will analyze and interpret CPT, HCPCS, ICD-10-CM and all other code sets for appropriate inclusion or exclusion in all Change Healthcare code auditing solutions.

  • The Clinical Content Developer/Analyst also works closely with the Analytics team to complete data analysis using benchmark data (or other available sources) to either identify new opportunity or validate/confirm content development.

  • The Clinical Content Developer/Analyst is responsible for the comprehensive analysis, content development and maintenance of all clinical content support.

  • Content development is defined as the identification of a clinical term, surgical procedure or medical condition and translating it into a procedure code, diagnosis code or any other code set element as appropriate.

The Clinical Content Developer/Analyst is responsible for the evaluation as well as the performance all applicable and time updates of the clinical content on a regular basis to be defined. These activities include but are not limited to:

  • Support the creation and development of content requirements, as necessary,

  • Executing the creation, appropriate interpretation and maintenance of clinical content

  • Assist internal and external customers in troubleshooting content issues (determine if outcome is a content defect and determine its criticality)

  • Perform Quality Assurance of clinical content to include: peer review of proposed content, validation measures to ensure content integrity, documentation of content assumptions and methodology as indicated as needed,

  • Present clinical content development questions and considerations to medical directors and clinical leadership for input and feedback; Developer/Analyst retains feedback and applies as directed

  • Provides accurate Subject Matter expertise (SME) on medical billing and coding topics, depending on background, as well as content developed,

  • Create, support and maintain Clinical User Documentation (internal and external product users) and ensure accuracy of all content reports on a monthly or quarterly basis.

  • Prepare, deliver and provide Clinical support related to clinical content to both internal and external customers.

  • Work on internal, cross functional teams focused on both internal and external software applications.

  • Serve as Clinical Content SME on cross-functional teams, as needed and communicate relevant information back to Clinical content team.

Minimum Job Qualifications:

  • American Academy of Professional Coders (AAPC) Certified Professional Coder’s (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required prior to hire date.

  • 5 years or more relevant healthcare experience as a medical coder, medical claims adjuster, medical claims processor or medical auditor.

  • Bachelor’s degree in, Healthcare Information System Management, Health Information Management or other Healthcare related degree desired.

  • Third party claims processing, Medicare/Commercial insurance billing, and/or accounts receivable follow-up analysis experience strongly preferred

  • Healthcare Systems Information technology background and/or experience with strongly preferred.

  • Health Plan experience strongly preferred

  • Experience with other Clinical Editing vendors strongly preferred

Specialized Knowledge/Skills –

  • National medical coding certification CPC or CCS-P is required.

  • Developer must possess strong and current working knowledge of CPT codes, HCPCS codes, ICD-10-CM codes and other code sets. (Medical coding skills assessment will be conducted prior to interview)

  • In depth knowledge of professional medical billing required; facility medical billing knowledge is a plus

  • Ability to successfully manage multiple priorities with deliverables completed on time and with high quality.

  • Research capabilities, writing experience, and current working knowledge of government and commercial payer guidelines required.

  • Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Outlook.

  • Ability to use Access at an intermediate level is a plus

  • Outstanding problem-solving skills; ability to step through logical pathways to confirm expected results.

  • Ability to perform independent study, as necessary

  • Strong analytical skills

  • Excellent communication, interpersonal, presentation/computer skills

  • Results oriented; effective as both a team member and independent worker with strong attention to detail

  • Basic understanding of software development phases/life cycles a plus

  • Aptitude for working with Change Healthcare developed applications in support of work objectives.

Working Conditions:

Environment (Office, warehouse, etc.) –

Physical Requirements (Lifting, standing, etc.) –

(This description is general in nature and is not intended to be an exhaustive list of all responsibilities. Other duties may be assigned as needed to meet company goals.)

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.